For help or more information, please contact

If your situation falls outside the criteria or is an exceptional circumstance, we may still be able to help you. Please contact the Welfare Vice President for more information.

Hardship Grant Application Form

Personal Details

Name *

Student ID *

Email *

Contact Phone Number *

Please leave this field empty.

Residential Address *

AUSA acknowledges and respects the privacy of individuals. AUSA Advocacy collects, stores, uses, updates, discloses and disposes of all personal information in accordance with the Privacy Act 1993.

Demographic Information

Degree

Year of Study *

1st

2nd

3rd

4th

Other (Specify)

Other

Level of Study *

Foundation

Undergrad

Masters

Diploma

PhD

Student Type *

Local

International

Gender

Ethnicity *

Pakeha

Māori

Pacific

Other (Please Specify)

Other

Number of Dependents (eg. children)

If you have dependents, what is your relationship to them?

How did you hear about us? *

Craccum

Student Advice Hub

Word of Mouth

SEF

AUSA Website

Lecture Speak

UniHealth

AUSA Reception

Other (Specify)

Other

Living and Employment Details

What is your living arrangement? *

Flatting with Others

Living with Dependants

Living Alone

Living with Parents

Private Board, Halls of Residence

Other (Specify)

Other

What is your employment status? *

Currently Employed

Currently Seeking Employment

Not currently employed or seeking employment

If you are currently seeking employment please explain what steps you have taken, or provide your Student Job Search number. If you are not currently employed and not seeking employment, please explain why you are unable to seek employment at this time

Bank Details

Name of Bank

Account Name

Account Number

Income Details

Student Allowance $

Student Loan Living Costs $

Scholarship or Grant $

Parental/Family Support $

Employment $

Other $

Total Weekly Income (A) $

Expense Details

Rent $

Food $

Transport $

Utilities (electricity etc) $

Phone (inc. mobile credit) $

Personal $

Entertainment $

Fines $

Loan/Credit Card payments $

Other $

Total Weekly Expenses (B) $

Balance Details

Total Income (A) - Total Expenses (B) = $

Situation Details

What are you applying for?

Food Assistance

Medical Assistance

Travel Assistance

Accommodation Assistance

Why are you applying for the Hardship Grant? Please answer this question in full in at least 250 words. If you would like to answer this in a Word document, please include this in the supporting documentation upload below.

Supporting Documentation

Please archive your supporting documents into a zip file and upload below (File size limit 6MB). This must include an accurate copy of all current bank accounts, including all transactions over the past two weeks.

I declare that all information provided by me is true and correct and that no relevant information has been withheld.

I declare that I have provided an accurate copy of all my current bank accounts, including all my transactions over the past two weeks.

I understand that if I have not provided the correct documentation or information to support my application it will not be processed.

I understand that all of the information and documentation I have provided in this application will remain completely confidential to the AUSA Welfare Committee, except for demographic information which may be used and published for statistical purposes.

I understand that the decision of the AUSA Welfare Committee is final.